What Causes Hair Loss?

The American Academy of Dermatology (AAD) notes that 80 million men and women in America have hereditary hair loss (alopecia). It can affect just the hair on your scalp or your entire body. Although it’s more prevalent in older adults, excessive... Read More

What Is Hair Loss?

The American Academy of Dermatology (AAD) notes that 80 million men and women in America have hereditary hair loss (alopecia). It can affect just the hair on your scalp or your entire body. Although it’s more prevalent in older adults, excessive hair loss can occur in children as well.

According to Kids Health, it’s normal to lose between 50 and 100 hairs a day. With about 100,000 hairs on your head, that small loss isn’t noticeable. New hair normally replaces the lost hair, but this doesn’t always happen. Hair loss can develop gradually over years or happen abruptly. Hair loss can be permanent or temporary.

It’s impossible to count the amount of hair lost on a given day. You may be losing more hair than is normal if you notice a large amount of hair in the drain after washing your hair or clumps of hair in your brush. You might also notice thinning patches of hair or baldness.

If you notice that you’re losing more hair than usual, you should discuss the problem with your doctor. They can determine the underlying cause of your hair loss and suggest appropriate treatment plans.

What Causes Hair Loss?

First, your doctor or dermatologist (a doctor who specializes in skin problems) will try to determine the underlying cause of your hair loss. The most common cause of hair loss is hereditary male- or female-pattern baldness. If you have a family history of baldness, you may have this type of hair loss. Certain sex hormones can trigger hereditary hair loss. It may begin as early as puberty.

In some cases, hair loss may occur with a simple halt in the cycle of hair growth. Major illnesses, surgeries, or traumatic events can trigger hair loss. However, your hair will usually start growing back without treatment.

Hormonal changes associated with pregnancy, childbirth, discontinuing the use of birth control pills, and menopause can cause temporary hair loss.

Medical conditions that can cause hair loss include thyroid disease, alopecia areata (an autoimmune disease that attacks hair follicles), and scalp infections like ringworm. Diseases that cause scarring, such as lichen planus and some types of lupus, can result in permanent hair loss because of the scarring.

Hair loss can also be due to medications used to treat cancer, high blood pressure, arthritis, depression, and heart problems.

A physical or emotional shock may trigger noticeable hair loss. Examples of this type of shock include a death in the family, extreme weight loss, or a high fever. People with trichotillomania (hair-pulling disorder) have a compulsion to pull out their hair, usually from their head, eyebrows, or eyelashes. Traction hair loss can be due to hairstyles that put pressure on the follicles by pulling the hair back very tightly.

A diet lacking in protein, iron, and other nutrients can lead to thinning hair.

How Is Hair Loss Diagnosed?

Persistent hair loss often indicates an underlying health issue. Your doctor or dermatologist can determine the cause of your hair loss based on a physical examination and your health history. In some cases, simple dietary changes can help, along with switching prescription medications.

If your dermatologist suspects an autoimmune or skin disease, they might take a biopsy of the skin on your scalp. This will involve carefully removing a small section of skin for laboratory testing. It’s important to keep in mind that hair growth is a complex process, so it may take time to determine the exact cause of your hair loss.

What Are the Treatment Options for Hair Loss?

Medication

Medications will likely be the first course of treatment for hair loss. Over-the-counter medications generally consist of topical creams and gels that you apply directly to the scalp. The most common products contain an ingredient called minoxidil (Rogaine). According to the AAD, your doctor may recommend minoxidil in conjunction with other hair loss treatments. Side effects of minoxidil include scalp irritation and hair growth in adjacent areas, such as your forehead or face.

Prescription medications may also treat hair loss. Doctors prescribe the oral medication finasteride (Propecia) for male-pattern baldness. You take this medication daily to slow hair loss. Some men experience new hair growth when taking finasteride. Rare side effects of this medication include diminished sex drive and impaired sexual function. There may be a link between use of finasteride and a fast-growing type of prostate cancer.

Doctor also prescribe corticosteroids like prednisone. Individuals with alopecia areata can use this to reduce inflammation and suppress the immune system. Corticosteroids mimic the hormones made by your adrenal glands. A high amount of corticosteroid in the body reduces inflammation and suppresses the immune system.

You should monitor side effects from these medications carefully. Possible side effects include:

glaucoma, a collection of eye diseases that can result in optic nerve damage and vision loss

fluid retention and swelling in the lower legs

higher blood pressure

cataracts

high blood sugar

There is evidence that corticosteroid use may also put you at higher risk for the following conditions:

infections

calcium loss from bones, which may lead to osteoporosis

thin skin and easy bruising

sore throat

hoarseness

Medical Procedures

Hair Transplant Surgery

Hair transplant surgery involves moving small plugs of skin, each with a few hairs, to bald parts of your scalp. This works well for people with inherited baldness since they typically lose hair on the top of the head. Because that type of hair loss is progressive, you would need multiple surgeries over time.

Scalp Reduction

In a scalp reduction, a surgeon removes part of your scalp that lacks hair. The surgeon then closes the area with a piece of your scalp that has hair. Another option is a flap, in which your surgeon folds scalp that has hair over a bald patch. This is a type of scalp reduction.Tissue expansion can also cover bald spots. It requires two surgeries. In the first surgery, a surgeon places a tissue expander under a part of the scalp that has hair and is next to the bald spot. After several weeks, the expander causes the growth of new skin cells. In the second surgery, your surgeon removes the expander and places the new skin with hair over the bald spot.

These surgical remedies for baldness tend to be expensive, and they carry risks. These include:

patchy hair growth

bleeding

wide scars

infection

Your graft might also not take, meaning that you would need to repeat the surgery.

How Can I Prevent Hair Loss?

There are things you can do to prevent further hair loss. Don’t wear tight hairstyles like braids, ponytails, or buns that put too much pressure on your hair. Over time, those styles permanently damage your hair follicles. Try not to pull, twist, or rub your hair. Make sure you have a balanced diet, and that you’re getting adequate amounts of iron and protein.

Styling products and tools are also common culprits in hair loss. Examples of products or tools that can affect hair loss are blow dryers, heated combs, hair straighteners, coloring products, bleaching agents, perms, and relaxers.

If you decide to style your hair with heated tools, only do so when your hair is damp or dry. Also, use the lowest settings possible.

What Is the Long-Term Outlook?

You can stop or even reverse hair loss with aggressive treatment, especially if it’s due to an underlying medical condition. Hereditary hair loss may be more difficult to treat, but certain procedures such as hair transplants can help reduce the appearance of baldness. Talk to your doctor to explore all your options to lessen the effects of hair loss.

Medically reviewed by Steve Kim, MD on February 29, 2016 — Written by Kristeen Moore